- Email: [email protected]
SKELETAL FLUOROSIS
777
the stated scatter of observations. The tests for significance apply to results including these errors. With 59Fe autoradiodifference in grain-counts graphs we have found"no significant control " and " stimulated " animals, over normoblasts in although the proportion of normoblasts --present is greatly reduced in the former. Reticulocytes do, of course, contribute to the iron utilisation, particularly if we take the 24-hour value, " unstimulated " polybut as the reticulocyte-count in cythaemic animals is of the order of 0-03%, factors stimulating haem synthesis alone will not give rise to false-positive results. The London Hospital, London, E.1.
D. G. PENINGTON.
NEUROLOGICAL COMPLICATIONS OF INFLUENZA recent influenza SIR,-The epidemic here, affecting especially the elderly, provided a forceful reminder of the many neurological complications in this disease.1 In descending order of incidence, these were:
(1) Brain-stem involvement with dysphagia, vomiting, &c. (2) Encephalitis with headache, photophobia, giddiness, vomiting, &c.
(3) Encephalomyelitis. (4) Autonomic neuropathy with diarrhoea, vomiting, and tachycardia. (5) Polyneuritis. City Hospital,
T. K. BOSE.
Chester.
OXYTETRACYCLINE PROPHYLAXIS IN CHRONIC BRONCHITIS
SIR,-From October, 1958,
to
March, 1959, 59
with severe chronic bronchitis were admitted with acute respiratory illnesses.
to
men
hospital
When they left, 32 men selected at random were each given 20 tablets (0-5 g.) of oxytetracycline and the following instructions : " If you have a severe head cold, or the phlegm becomes yellow or green, or you feel that you are beginning with a chest illness, take 1 tablet after breakfast, dinner, tea, and supper." Further tablets were given if necessary. Before the trial ended in March, 1960, 20 of these patients had taken 36 courses of oxytetracycline, which prevented serious respiratory illnesses in 15. 5 men were readmitted, 2 because of bronchospasm, and 3 with reinfection; 1 of the latter had failed to follow the instructions. None of the trial patients died. 7 of the 27 controls were readmitted to this hospital, and 2 died; 6 other control patients died during the trial period. These results are encouraging, and we prefer this method to the continuous administration of antibiotics. 23 Whiston Hospital, Prescot, Lancashire. Pfizer Ltd., Folkestone, Kent.
E. SHERWOOD JONES J. E. FORSTER.
J. K. MORRISON.
TREATMENT OF RECENT BELL’S PALSY BY CERVICAL SYMPATHETIC BLOCK
SIR,-The treatment of the complete type of Bell’s palsy by cervical sympathetic block recently reported by Mr. Boyes Korkis (Feb. 4) has made a great difference to the work of physical medicine departments. Before, such cases could be divided into those which recovered within three to four weeks of onset, and those in which recovery was extremely slow and which finally were left with weakness, contractures, or overaction, after three years of
physiotherapy. With sympathetic block, most recent cases (93%) can now be placed in the first category, with immediate or nearly immediate recovery; and no call is made upon the physio-
therapy services. 1. 2. 3.
Leigh, A. D. Brit. med. J. 1946, ii, 936. Edwards, G., Fear, E. C. Brit. med. J. 1958, ii, 1010. Murdoch, J. M., Leckie, W. J. H., Downie, J., Swain, R. H. A., Gould, J. C. ibid. 1959, ii, 1277.
Facial palsy is now rarely seen in the physical medicine department. Only late and complicated cases (thrombotic, arteriosclerotic, infective, post-traumatic, and those with geniculate herpes) are encountered. Very nearly all cases of facial palsy appear to be of the vasospastic type (true Bell’s palsy); and by early and rapid relief of angiospasm facial nerve function can be completely restored without physiotherapy. Hillingdon Hospital, Hillingdon, Middlesex.
R.
J. TALBOT.
BEHAVIOUR THERAPY IN TRANSVESTISM
SIR,-In their interesting letters, Dr. Barker and his colleagues (March 4) and Dr. Glynn and Dr. Harper (March 18) describe the apparently successful treatment of transvestism by aversion therapy using apomorphine injections. I should like to point out that the treatment of cases of transvestism along these lines may not always be so straightforward. Experience of the apparent cure by this treatment of rubberclothing fetishism (follow-up fifteen months and six months) led me to apply similar treatment recently to a 37-year-old fetishist, whose practices dated from early childhood. Apomorphine injections two-hourly, combined with dressing up in female clothing, were used day and night for five days, with pilocarpine nitrate in addition when the effects of the apomorphine began to wane. In the course of treatment, the patient, unlike the fetishists, failed to show aggression or refusal to don the clothes, and previously underestimated masochistic traits became evident. This treatment was carried out in the week before the letter of Dr. Barker and his colleagues. It is not yet certain whether, like the two fetishists, this man will have become indifferent to the clothing, but, since the time of treatment, he has remained in a condition of severe agitation and depression, with suicidal
thoughts. Department of Psychological Medicine,
University of Edinburgh.
SIR,-In would like
IAN OSWALD.
SKELETAL FLUOROSIS reply to Dr. Alcock’s letter
(March 11) I dental fluorosis, and on the of adding sodium fluoride to
to comment on
safety and desirability public water-supplies. In my original letter (Feb. 18) I did not say that I was confining my remarks on dental fluorosis to the situation in temperate climates, since the proposal to fluoridate water is a matter which may affect people in all climates. Galagan and Lamson1 show quite clearly that at concentrations of less than 1 part per million (p.p.m.) objectionable mottling occurs in the hot zone (temp. 69-3°F) and less objectionable mottling in the temperate zone (temp. 50’6°F). The more objectionable mottling, as the authors suggest, is probably related to the increased water consumption and the fact that the preparation of the dietary staple (beans) could concentrate the fluorides. Since the question of temperature has been raised, readers may like to know that marked dental mottling can occur with low concentrations of fluorine in water in this country. Kemp et al.2 describe severe dental fluorosis in two villages in Oxfordshire where the watersupplies contained 0-8 p.p.m. and 0-3-1-2 p.p.m. respectively. Forrestdescribes objectionable mottling in Essex and Surrey where the fluorine content is 0-1-0-2 p.p.m., but regards this as a developmental hypoplasia. Despite the assurance of the W.H.O. report that 1-0-1-5 p.p.m. will cause only slight flecking of the enamel, it has been estimated that more than 200,000 children in the U.S.A. have already become victims of definite life-time mottling since artificial 1. Galagan, D. J., Lamson, G. G., Jr. Publ. Hlth Rep., Wash. 1953, 68, 497. 2. Kemp, F. H., Murray, M. M., Wilson, D. C. Lancet, 1942, ii, 93. 3. Forrest, J. R. Roy. Soc. Hlth J. 1957, 77, 349. 4. World Health Organisation Technical Report Series, 1958, no, 146;
p. 5.
778 fluoridation of water was introduced. Dental fluorosis now has the highest incidence of any waterborne disease in the United States. Can we wonder that not only are fewer cities taking on fluoridation, but also many with fluoridation pro5 grammes are dropping them.
In my second letter (March 4) on safety and desirability I wrote " there has been no adequate scientific which inquiry proves that such a measure is either desirable or safe ". This is not my isolated view as Dr. Alcock suggests; it is also the opinion of a great many serious thinkers in the medical, dental, and other professions. The following five extracts are a few of the many adverse comments appearing after the W.H.O. report of 1958.
example to the rest of the civilised world by dealing with the major cause-a sophisticated and chemically adulterated food-supply. This is not an impossible or impracti:able task. Institute of Pathology, The Royal Infirmary, Cardiff.
R. A. HOLMAN.
...
(1) " The sound basis on which the efficacy of a publichealth measure must be assessed is not provided by these five crucial trials."6 (2) " The propaganda in favour of primitive and scientifically unconvincing work must be viewed with great suspicion."7 (3) " After 15 years of zealous promotion it is obvious that the original claims and promises of reduction in dental decay were not soundly based and grossly overrated any reasonably anticipated benefit. Such claims as 65% reduction in dental decay remain slogans without convincing scientific support."5 (4) The Association of American Physicians and Surgeons condemn the addition of any substance to public watersupplies for the purpose of affecting the bodies or bodily or mental functions of the consumers ".s8 (5) " The onus of proving that fluoridation is beneficial to teeth rests upon those who assert it, and so does the onus of proving that the continuous ingestion of fluorides involves no risk of accumulative toxicity. This onus of proof has not been satisfactorily discharged. Even if it were, the only conclusion to be drawn would be that it is permissible for doctors who believe in the efficacy of fluorides to prescribe them. But no conclusion could be drawn that it is right to force fluorides upon a whole population via their public water-supplies, for that raises a fundamental question of human rights upon which no doctor or dentist is entitled to adjudicate." 9 We must remember that fluorine is the most active element known 10 and is a powerful oxidising agent. It is also a potent enzyme poison and Prof. Hugo Theorell (awarded the Nobel prize for his work on oxidative enzymes) bases his objection to fluoridation on this point. Fluoride, like cyanide, can form a spectroscopically recognisable compound with the enzyme catalase which inhibits it." Catalase plays a vital role in cell respiration and its inhibition is known to be linked with cancer, mutation, the creation of viruses, and the activity of hormones, &c.
No, Sir, the case so far presented for artificially fluoridating drinking-water for human consumption is not ethical, safe, scientific, or desirable. Sir Wilfred Fish 12 has pointed out that dental caries is a disease which is (1) unknown in communities to which civilisation has not spread and (2) linked with the civilised diet. Professor MacGregor 13 and a recent leader in the British Medical Journal14 support the second point, and all three articles agree that it is widely accepted that this condition can be largely prevented by dietary means. We in Britain with such a high incidence of dental decay have a golden opportunity to set an 5. Medical-Dental Committee on Evaluation of Fluoridation. Report. New York City, 1960. 6. Sutton, P. R. N. Fluoridation: Errors and Omissions in Experimental Trials. Melbourne, 1959. 7. Polya, J. B. Proc. R. Aust. chem. Inst.; 1960 27, p. 354. 8. Canadian Intelligence Service, 1959, 9, no. 8; 4. (Canadian Intelligence
Publications Ltd., Ontario.) 9. Douglas of Barloch. Edmonton Pure Water Association, March 1, 1960. (P.O. box 624, Edmonton, Alberta). 10. Partington, J. R. General Inorganic Chemistry; p. 766. London, 1958. 11. Baldwin, E. Dynamic Aspects of Biochemistry; p. 158. London, 1957. 12. Fish, W. Roy. Soc. Hlth J. 1957, 77, 340. 13. MacGregor, A. L. New Scientist, 1959, 5, 451. 14. British Medical Journal, 1961, i, 262.
Parliament Progress of N.H.S. Legislation IN contrast with its protracted progress through the House of Commons, where it received a third reading on March 16, the National Health Service Contributions Bill went through all its legislative stages in the House of Lords on March 27 in about an hour. The Bill received the Royal Assent on March 28. Under an order announced by the Treasury, July 3 has been appointed as the day from which the increased contributions will come into effect. The National Health Service Bill, which makes further provision for charges for the dental and optical services, was read a third time in the House of Commons on March 29 and a first time in the House of Lords on March 30. Winding up the debate on the third reading in the Commons, Mr. ENOCH PowELL said that, according to the original estimate, the gross expenditure on the N.H.S. would be E886 million, a figure which represented a higher proportion of the national income than had ever been applied in this country to health services. The net figure, which was the Exchequer contribution, controlled the extent to which we were able to expand the service, It expanded by 61/2% the year before last; by 811z% last year. Next year, even after all these charges, it would still be up by a further 3 %. Given that there was a limit-and inevitably there must be a limit to the net cost of the service-the extent to which we could go forward in its expansion depended on the sources of finance which we could obtain from elsewhere, and he challenged any hon. Member to say that it was more important that the sum of E65 million which emerged from all the new charges, should be devoted to maintaining the status quo rather than to carrying forward the expansion of the service.
QUESTION TIME Urgent Operations for Children Dr. DONALD JOHNSON asked the Minister of Health what guidance he was giving to hospital management committees in regard to the initiation of procedures leading to the establishment of special children’s courts in hospitals in cases where the parents of children have refused their consent to urgent operations.-Mr. PowELL replied: I have advised hospital authorities not to resort to the " care or protection " procedure. but to rely on the clinical judgment of the consultants concerned after full discussion with the parents. Industrial Accidents 1960 there were 12,651 industrial accidents affecting During young workers. This is an increase of 1650 (or 15°o) over the figure for 1959.
Appointments DAVIE, R. D. M., M.B. Edin., F.F.A. R.c.s.: consultant anaesthetist, cuuntv .n; city of Perth general hospitals group. HOSKING, D. J., M.B. Lond., D.P.H. : senior assistant M.o., 0ttinbrr. McLEOD, NORMAN, M.B. St. And., F.F.A. R.C.S.: consultant ar.J:S-.c’:St county and city of Perth general hospitals group. McNAMARA, HILDA E., M.D. Toronto, D.OBST., D.P.H. : maternal r.d J:1l; welfare M.o., Derbyshire.
Birmingham Regional Hospital Board: BILLINGTON, J. G., M.A. Cantab., M.R.C.S. : s.H.M.o. in geriatrics, S::c:T";. field Hospital, Birmingham. LlU, MEI-CHEN, M.D. Cheeloo, D.P.M. : consultant psychiaLrist, Jtcr.vW Hospital, Birmingham. SAGE, R. H., M.B. Birm., F.R.C.S. : consultant surgeon, Selly Oak HM;-.’.. Birmingham. ZOLLMAN, LEO, M.D. Prague, D.P.M.: consultant psychiatrist, Bar!’5: Hall Hospital, Bromsgrove.
the stated scatter of observations. The tests for significance apply to results including these errors. With 59Fe autoradiodifference in grain-counts graphs we have found"no significant control " and " stimulated " animals, over normoblasts in although the proportion of normoblasts --present is greatly reduced in the former. Reticulocytes do, of course, contribute to the iron utilisation, particularly if we take the 24-hour value, " unstimulated " polybut as the reticulocyte-count in cythaemic animals is of the order of 0-03%, factors stimulating haem synthesis alone will not give rise to false-positive results. The London Hospital, London, E.1.
D. G. PENINGTON.
NEUROLOGICAL COMPLICATIONS OF INFLUENZA recent influenza SIR,-The epidemic here, affecting especially the elderly, provided a forceful reminder of the many neurological complications in this disease.1 In descending order of incidence, these were:
(1) Brain-stem involvement with dysphagia, vomiting, &c. (2) Encephalitis with headache, photophobia, giddiness, vomiting, &c.
(3) Encephalomyelitis. (4) Autonomic neuropathy with diarrhoea, vomiting, and tachycardia. (5) Polyneuritis. City Hospital,
T. K. BOSE.
Chester.
OXYTETRACYCLINE PROPHYLAXIS IN CHRONIC BRONCHITIS
SIR,-From October, 1958,
to
March, 1959, 59
with severe chronic bronchitis were admitted with acute respiratory illnesses.
to
men
hospital
When they left, 32 men selected at random were each given 20 tablets (0-5 g.) of oxytetracycline and the following instructions : " If you have a severe head cold, or the phlegm becomes yellow or green, or you feel that you are beginning with a chest illness, take 1 tablet after breakfast, dinner, tea, and supper." Further tablets were given if necessary. Before the trial ended in March, 1960, 20 of these patients had taken 36 courses of oxytetracycline, which prevented serious respiratory illnesses in 15. 5 men were readmitted, 2 because of bronchospasm, and 3 with reinfection; 1 of the latter had failed to follow the instructions. None of the trial patients died. 7 of the 27 controls were readmitted to this hospital, and 2 died; 6 other control patients died during the trial period. These results are encouraging, and we prefer this method to the continuous administration of antibiotics. 23 Whiston Hospital, Prescot, Lancashire. Pfizer Ltd., Folkestone, Kent.
E. SHERWOOD JONES J. E. FORSTER.
J. K. MORRISON.
TREATMENT OF RECENT BELL’S PALSY BY CERVICAL SYMPATHETIC BLOCK
SIR,-The treatment of the complete type of Bell’s palsy by cervical sympathetic block recently reported by Mr. Boyes Korkis (Feb. 4) has made a great difference to the work of physical medicine departments. Before, such cases could be divided into those which recovered within three to four weeks of onset, and those in which recovery was extremely slow and which finally were left with weakness, contractures, or overaction, after three years of
physiotherapy. With sympathetic block, most recent cases (93%) can now be placed in the first category, with immediate or nearly immediate recovery; and no call is made upon the physio-
therapy services. 1. 2. 3.
Leigh, A. D. Brit. med. J. 1946, ii, 936. Edwards, G., Fear, E. C. Brit. med. J. 1958, ii, 1010. Murdoch, J. M., Leckie, W. J. H., Downie, J., Swain, R. H. A., Gould, J. C. ibid. 1959, ii, 1277.
Facial palsy is now rarely seen in the physical medicine department. Only late and complicated cases (thrombotic, arteriosclerotic, infective, post-traumatic, and those with geniculate herpes) are encountered. Very nearly all cases of facial palsy appear to be of the vasospastic type (true Bell’s palsy); and by early and rapid relief of angiospasm facial nerve function can be completely restored without physiotherapy. Hillingdon Hospital, Hillingdon, Middlesex.
R.
J. TALBOT.
BEHAVIOUR THERAPY IN TRANSVESTISM
SIR,-In their interesting letters, Dr. Barker and his colleagues (March 4) and Dr. Glynn and Dr. Harper (March 18) describe the apparently successful treatment of transvestism by aversion therapy using apomorphine injections. I should like to point out that the treatment of cases of transvestism along these lines may not always be so straightforward. Experience of the apparent cure by this treatment of rubberclothing fetishism (follow-up fifteen months and six months) led me to apply similar treatment recently to a 37-year-old fetishist, whose practices dated from early childhood. Apomorphine injections two-hourly, combined with dressing up in female clothing, were used day and night for five days, with pilocarpine nitrate in addition when the effects of the apomorphine began to wane. In the course of treatment, the patient, unlike the fetishists, failed to show aggression or refusal to don the clothes, and previously underestimated masochistic traits became evident. This treatment was carried out in the week before the letter of Dr. Barker and his colleagues. It is not yet certain whether, like the two fetishists, this man will have become indifferent to the clothing, but, since the time of treatment, he has remained in a condition of severe agitation and depression, with suicidal
thoughts. Department of Psychological Medicine,
University of Edinburgh.
SIR,-In would like
IAN OSWALD.
SKELETAL FLUOROSIS reply to Dr. Alcock’s letter
(March 11) I dental fluorosis, and on the of adding sodium fluoride to
to comment on
safety and desirability public water-supplies. In my original letter (Feb. 18) I did not say that I was confining my remarks on dental fluorosis to the situation in temperate climates, since the proposal to fluoridate water is a matter which may affect people in all climates. Galagan and Lamson1 show quite clearly that at concentrations of less than 1 part per million (p.p.m.) objectionable mottling occurs in the hot zone (temp. 69-3°F) and less objectionable mottling in the temperate zone (temp. 50’6°F). The more objectionable mottling, as the authors suggest, is probably related to the increased water consumption and the fact that the preparation of the dietary staple (beans) could concentrate the fluorides. Since the question of temperature has been raised, readers may like to know that marked dental mottling can occur with low concentrations of fluorine in water in this country. Kemp et al.2 describe severe dental fluorosis in two villages in Oxfordshire where the watersupplies contained 0-8 p.p.m. and 0-3-1-2 p.p.m. respectively. Forrestdescribes objectionable mottling in Essex and Surrey where the fluorine content is 0-1-0-2 p.p.m., but regards this as a developmental hypoplasia. Despite the assurance of the W.H.O. report that 1-0-1-5 p.p.m. will cause only slight flecking of the enamel, it has been estimated that more than 200,000 children in the U.S.A. have already become victims of definite life-time mottling since artificial 1. Galagan, D. J., Lamson, G. G., Jr. Publ. Hlth Rep., Wash. 1953, 68, 497. 2. Kemp, F. H., Murray, M. M., Wilson, D. C. Lancet, 1942, ii, 93. 3. Forrest, J. R. Roy. Soc. Hlth J. 1957, 77, 349. 4. World Health Organisation Technical Report Series, 1958, no, 146;
p. 5.
778 fluoridation of water was introduced. Dental fluorosis now has the highest incidence of any waterborne disease in the United States. Can we wonder that not only are fewer cities taking on fluoridation, but also many with fluoridation pro5 grammes are dropping them.
In my second letter (March 4) on safety and desirability I wrote " there has been no adequate scientific which inquiry proves that such a measure is either desirable or safe ". This is not my isolated view as Dr. Alcock suggests; it is also the opinion of a great many serious thinkers in the medical, dental, and other professions. The following five extracts are a few of the many adverse comments appearing after the W.H.O. report of 1958.
example to the rest of the civilised world by dealing with the major cause-a sophisticated and chemically adulterated food-supply. This is not an impossible or impracti:able task. Institute of Pathology, The Royal Infirmary, Cardiff.
R. A. HOLMAN.
...
(1) " The sound basis on which the efficacy of a publichealth measure must be assessed is not provided by these five crucial trials."6 (2) " The propaganda in favour of primitive and scientifically unconvincing work must be viewed with great suspicion."7 (3) " After 15 years of zealous promotion it is obvious that the original claims and promises of reduction in dental decay were not soundly based and grossly overrated any reasonably anticipated benefit. Such claims as 65% reduction in dental decay remain slogans without convincing scientific support."5 (4) The Association of American Physicians and Surgeons condemn the addition of any substance to public watersupplies for the purpose of affecting the bodies or bodily or mental functions of the consumers ".s8 (5) " The onus of proving that fluoridation is beneficial to teeth rests upon those who assert it, and so does the onus of proving that the continuous ingestion of fluorides involves no risk of accumulative toxicity. This onus of proof has not been satisfactorily discharged. Even if it were, the only conclusion to be drawn would be that it is permissible for doctors who believe in the efficacy of fluorides to prescribe them. But no conclusion could be drawn that it is right to force fluorides upon a whole population via their public water-supplies, for that raises a fundamental question of human rights upon which no doctor or dentist is entitled to adjudicate." 9 We must remember that fluorine is the most active element known 10 and is a powerful oxidising agent. It is also a potent enzyme poison and Prof. Hugo Theorell (awarded the Nobel prize for his work on oxidative enzymes) bases his objection to fluoridation on this point. Fluoride, like cyanide, can form a spectroscopically recognisable compound with the enzyme catalase which inhibits it." Catalase plays a vital role in cell respiration and its inhibition is known to be linked with cancer, mutation, the creation of viruses, and the activity of hormones, &c.
No, Sir, the case so far presented for artificially fluoridating drinking-water for human consumption is not ethical, safe, scientific, or desirable. Sir Wilfred Fish 12 has pointed out that dental caries is a disease which is (1) unknown in communities to which civilisation has not spread and (2) linked with the civilised diet. Professor MacGregor 13 and a recent leader in the British Medical Journal14 support the second point, and all three articles agree that it is widely accepted that this condition can be largely prevented by dietary means. We in Britain with such a high incidence of dental decay have a golden opportunity to set an 5. Medical-Dental Committee on Evaluation of Fluoridation. Report. New York City, 1960. 6. Sutton, P. R. N. Fluoridation: Errors and Omissions in Experimental Trials. Melbourne, 1959. 7. Polya, J. B. Proc. R. Aust. chem. Inst.; 1960 27, p. 354. 8. Canadian Intelligence Service, 1959, 9, no. 8; 4. (Canadian Intelligence
Publications Ltd., Ontario.) 9. Douglas of Barloch. Edmonton Pure Water Association, March 1, 1960. (P.O. box 624, Edmonton, Alberta). 10. Partington, J. R. General Inorganic Chemistry; p. 766. London, 1958. 11. Baldwin, E. Dynamic Aspects of Biochemistry; p. 158. London, 1957. 12. Fish, W. Roy. Soc. Hlth J. 1957, 77, 340. 13. MacGregor, A. L. New Scientist, 1959, 5, 451. 14. British Medical Journal, 1961, i, 262.
Parliament Progress of N.H.S. Legislation IN contrast with its protracted progress through the House of Commons, where it received a third reading on March 16, the National Health Service Contributions Bill went through all its legislative stages in the House of Lords on March 27 in about an hour. The Bill received the Royal Assent on March 28. Under an order announced by the Treasury, July 3 has been appointed as the day from which the increased contributions will come into effect. The National Health Service Bill, which makes further provision for charges for the dental and optical services, was read a third time in the House of Commons on March 29 and a first time in the House of Lords on March 30. Winding up the debate on the third reading in the Commons, Mr. ENOCH PowELL said that, according to the original estimate, the gross expenditure on the N.H.S. would be E886 million, a figure which represented a higher proportion of the national income than had ever been applied in this country to health services. The net figure, which was the Exchequer contribution, controlled the extent to which we were able to expand the service, It expanded by 61/2% the year before last; by 811z% last year. Next year, even after all these charges, it would still be up by a further 3 %. Given that there was a limit-and inevitably there must be a limit to the net cost of the service-the extent to which we could go forward in its expansion depended on the sources of finance which we could obtain from elsewhere, and he challenged any hon. Member to say that it was more important that the sum of E65 million which emerged from all the new charges, should be devoted to maintaining the status quo rather than to carrying forward the expansion of the service.
QUESTION TIME Urgent Operations for Children Dr. DONALD JOHNSON asked the Minister of Health what guidance he was giving to hospital management committees in regard to the initiation of procedures leading to the establishment of special children’s courts in hospitals in cases where the parents of children have refused their consent to urgent operations.-Mr. PowELL replied: I have advised hospital authorities not to resort to the " care or protection " procedure. but to rely on the clinical judgment of the consultants concerned after full discussion with the parents. Industrial Accidents 1960 there were 12,651 industrial accidents affecting During young workers. This is an increase of 1650 (or 15°o) over the figure for 1959.
Appointments DAVIE, R. D. M., M.B. Edin., F.F.A. R.c.s.: consultant anaesthetist, cuuntv .n; city of Perth general hospitals group. HOSKING, D. J., M.B. Lond., D.P.H. : senior assistant M.o., 0ttinbrr. McLEOD, NORMAN, M.B. St. And., F.F.A. R.C.S.: consultant ar.J:S-.c’:St county and city of Perth general hospitals group. McNAMARA, HILDA E., M.D. Toronto, D.OBST., D.P.H. : maternal r.d J:1l; welfare M.o., Derbyshire.
Birmingham Regional Hospital Board: BILLINGTON, J. G., M.A. Cantab., M.R.C.S. : s.H.M.o. in geriatrics, S::c:T";. field Hospital, Birmingham. LlU, MEI-CHEN, M.D. Cheeloo, D.P.M. : consultant psychiaLrist, Jtcr.vW Hospital, Birmingham. SAGE, R. H., M.B. Birm., F.R.C.S. : consultant surgeon, Selly Oak HM;-.’.. Birmingham. ZOLLMAN, LEO, M.D. Prague, D.P.M.: consultant psychiatrist, Bar!’5: Hall Hospital, Bromsgrove.